Montag Eduardo, Ueda Thiago, Okada Alberto, Onishi Bruno, Gemperli Rolf
1Cancer Institute of São Paulo (ICESP), University of São Paulo, Alameda Campinas, 977 3 floor, São Paulo, Brazil.
2Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil.
Eur J Plast Surg. 2018;41(1):41-48. doi: 10.1007/s00238-017-1371-2. Epub 2017 Nov 25.
Flap coverage is the gold standard in treating pressure sores, and due to the high recurrence rate, the possibility of multiple surgical procedures should be considered during flap selection. The gluteal thigh (GT) flap has become a workhorse for ischiatic pressure sore treatment at our hospital. Follow-up revealed a group of patients presenting recurrence of the pressure sore that needed a second flap. The inferior gluteal artery perforator (IGAP) flap was chosen in this series. The positive experience with both flaps raised the question of which flap should be the first option for the treatment of ischiatic and perineal pressure sores.
IGAP and GT flaps were dissected in 21 fresh human cadavers to allow comparison of anatomical features. In a series of 60 patients, the authors used both the gluteal thigh and the IGAP flap to cover 76 ischiatic and perineal ulcers.
The IGAP flap was found to be wider and thicker than the gluteal thigh, but presented a shorter pedicle. All flaps healed uneventfully. Recurrent ulcers were treated successfully with both flaps.
Both flaps are suitable for coverage ischiatic and perineal sores. Due to its anatomical features, the IGAP flap should be considered the first choice of treatment for ischiatic ulcers. The gluteal thigh flap should be used in the recurrent sores.Level of Evidence: Level IV, therapeutic study.
皮瓣覆盖是治疗压疮的金标准，由于复发率高，在选择皮瓣时应考虑多次手术的可能性。臀股（GT）皮瓣已成为我院治疗坐骨压疮的常用方法。随访发现一组患者压疮复发，需要再次进行皮瓣手术。本系列选择了臀下动脉穿支（IGAP）皮瓣。这两种皮瓣的良好经验引发了一个问题，即哪种皮瓣应作为治疗坐骨和会阴压疮的首选。
在21具新鲜人体尸体上解剖IGAP和GT皮瓣，以比较解剖学特征。在一系列60例患者中，作者使用臀股皮瓣和IGAP皮瓣覆盖76处坐骨和会阴溃疡。
发现IGAP皮瓣比臀股皮瓣更宽更厚，但蒂较短。所有皮瓣均顺利愈合。两种皮瓣均成功治疗了复发性溃疡。
两种皮瓣均适用于覆盖坐骨和会阴溃疡。由于其解剖学特征，IGAP皮瓣应被视为坐骨溃疡治疗的首选。臀股皮瓣应用于复发性溃疡。证据级别：IV级，治疗性研究。
